Higher patellofemoral compressive force does not affect anterior knee pain in anatomical bi-cruciate retaining total knee arthroplasty: In vivo prospective analysis of guided motion prosthesis.

BACKGROUND: The purposes of the present study are 1) to measure intraoperative patellofemoral compressive force in patients undergoing anatomical bi-cruciate retaining total knee arthroplasty and to assess the relationship between intraoperative patellofemoral compressive force and patient reported outcome measurements and 2) to compare patellofemoral compressive force and patient reported outcome measurements among patients who underwent anatomical bi-cruciate retaining, cruciate retaining, and bi-cruciate stabilized total knee arthroplasty. METHODS: Twenty-two patients with varus osteoarthritis of the knee who underwent anatomical bi-cruciate retaining total knee arthroplasty, 20 patients who underwent cruciate retaining total knee arthroplasty, and 24 patients who underwent bi-cruciate stabilized total knee arthroplasty were assessed. Patient reported outcome measurements were evaluated at 1.5 years after surgery. FINDINGS: Intraoperative patellofemoral compressive force was significantly lower with anatomical bi-cruciate retaining total knee arthroplasty than with cruciate retaining total knee arthroplasty at 60° to 140° of flexion and nearly equivalent to intraoperative patellofemoral compressive force with bi-cruciate stabilized total knee arthroplasty at all knee flexion angles examined. With anatomical bi-cruciate retaining total knee arthroplasty, there were no significant correlations between intraoperative patellofemoral compressive force and almost all patient reported outcome measurements except for 2011 Knee Society Score expectations, which was positively correlated with patellofemoral compressive force at 10° of flexion, and Patella score quadriceps strength, which was negatively correlated with patellofemoral compressive force at 60° of flexion. INTERPRETATION: There were no significant correlations between intraoperative patellofemoral compressive force and anterior knee pain after anatomical bi-cruciate retaining total knee arthroplasty. Evidence level: 3.

Robotic-Assisted Total Knee Arthroplasty for Distal Femur Fracture with Lateral Knee Osteoarthritis.

Introduction. Open reduction and internal fixation (ORIF) of compound fractures around the knee in elderly patient raise concerns about long-term postoperative external fixation and complications. Total knee arthroplasty (TKA) has been proposed as an alternative solution. We report a case where robotic-assisted (RA) TKA was used to treat lateral knee osteoarthritis (OA) with distal femur fracture. Case Presentation. A 90-year-old female visited our hospital with complications of sustained knee pain after a fall at home. Fracture line from the trochlea to the intercondylar notch was diagnosed on plain radiographs, and prior to this injury, the patient was receiving conservative treatment for lateral OA. We selected a conventional TKA over ORIF because the latter is associated with residual pain and the need for long-term immobilization, which can lead to other complications. However, the fracture site was the entry point for intramedullary rod, and there was concern that the fracture site would be displaced by conventional TKA. Therefore, the unique aspect of the case is that the technique utilized involved robotic milling using the Navio system while temporarily stabilizing the fracture using two tracker pins. RA TKA could determine osteotomy and implant placement by predicting the postoperative patient's soft tissue balance for no medial loosening and lateral contracture. The arthritic cartilage and bone were then methodically removed using the handheld sculptor. After immobilizing the fracture site with a bone grasper before removing the pin tracker, reaming of the femur and insertion of a stem prosthesis with semiconstrained were performed. Primary RA TKA is a viable option for intra-articular fractures in elderly patients with advanced knee osteoarthritis.

Robotic-assisted total knee arthroplasty improves the outlier of rotational alignment of the tibial prosthesis using 3DCT measurements.

BACKGROUND: The aim of the present study was to compare the accuracy of prosthetic alignment with three-dimensional computed tomography (3DCT) measurements following total knee arthroplasty (TKA) performed using a robotic-assisted surgical technique versus a conventional TKA. METHODS: 41 TKAs were performed with a handheld robotic-assisted surgical procedure (Robot group) between 2019 and 2020. Another 41 patients underwent TKA with a conventional manual surgical procedure (Manual group) using the same prosthesis. The operation durations between both groups were investigated. 3DCT scans of the entire lower extremities were taken before and after the surgery and femoral and tibial alignments in the coronal, sagittal, and axial planes were measured using computer software. The differences in prosthetic alignment and translation between the preoperative 3DCT plan and postoperative 3DCT image were also measured. RESULTS: There were no statistically significant differences in the post-operative outliers of the femorotibial angle between the groups. In the tibial-axial plane, the mean of prosthetic alignment in the anteroposterior plane was 4.0° in the Robot group and 6.7° in the Manual group (p < 0.01). The rate of outliers for tibial-axial alignment in the Robot group was significantly less than in the Manual group (p < 0.01). There were no statistically significant differences in prosthetic translation in the proximal-distal, anterior-posterior and medial-lateral orientations between the groups. CONCLUSIONS: In a radiologic study using 3DCT, robotic-assisted TKA reduced the outliers for rotational alignment of the tibial prosthesis in comparison to conventional TKA, which can lead to improved tracking of the femoral-tibial bearing surfaces.

Anatomical bi-cruciate retaining TKA improves gait ability earlier than bi-cruciate stabilized TKA based on triaxial accelerometery data: A prospective cohort study.

BACKGROUND: Total knee arthroplasty (TKA) is a common and cost-effective surgical treatment for osteoarthritis of the knee. However, only 82-89% of patients who performed TKA are satisfied with the postoperative outcomes. Therefore, bi-cruciate retaining (BCR) TKA is re-attracting attention. By retaining the anterior cruciate ligament (ACL), the knee may obtain the kinematic pathway that are closer to the native knee. The aim of the present study is to compare the ability to walk before and after surgery in patients who underwent bi-cruciate retaining total knee arthroplasty (BCR TKA) versus bi-cruciate stabilized (BCS) TKA during the early postoperative period. METHODS: Subjects included patients who underwent BCR TKA (10 knees) and BCS TKA (15 knees). We administered 10-meter gait tests before surgery and at 6 weeks and 3 months after surgery. We collected the following triaxial accelerometery data with a portable gait analyzer: walking time, number of steps, velocity, stride length, and coefficient of variability (CV) of double-leg support time while walking. RESULTS: Patients who underwent BCR TKA improved their gait ability [walking time (p < 0.01), number of steps (p < 0.05), velocity (p < 0.01), and stride length (p < 0.01) more than those who received BCS TKA at 6 weeks after surgery. BCR TKA improved gait ability (walking time, number of steps, velocity, and stride length) more than BCS TKA at 6 weeks after surgery. At 6 weeks after surgery, CV of double-leg support time while walking improved more in the BCR TKA group than in the BCS TKA group (p < 0.05). CONCLUSIONS: BCR TKA is associated with improved gait ability in the early postoperative period.

Tubulointerstitial nephritis antigen-like 1 is expressed in the uterus and binds with integrins in decidualized endometrium during postimplantation in mice.

Extracellular matrix substrates contribute to both uterine and blastocyst functions during the peri-implantation period. Tubulointerstitial nephritis antigen-like 1 (TINAGL1, also known as adrenocortical zonation factor 1 [AZ-1] or lipocalin 7) is a novel matricellular protein that promotes cell adhesion and spreading. However, the physiological roles of TINAGL1 are still not clearly understood. We examined the expression and localization of TINAGL1 in peri-implantation mouse uteri. During the preimplantation period, TINAGL1 was expressed in the basement membranes of uterine luminal epithelial cells on Days 1 and 2 of pregnancy, while its expression levels declined after Day 3. In the whole uteri, the expression levels of Tinagl1 mRNA and TINAGL1 protein were similar on Days 1-4 of pregnancy. In contrast, the expression of Tinagl1 mRNA and TINAGL1 protein increased in postimplantation uteri. From Days 6 to 8, TINAGL1 was markedly expressed in the decidual endometrium. TINAGL1 is a ligand for integrins and promotes cell adhesion in cultured cells. Therefore, to address whether TINAGL1 interacts with integrins in the uterus, immunohistochemical analysis and immunoprecipitation were performed. Immunohistochemical analysis showed that ITGA2, ITGA5, and ITGB1 were expressed in stromal cells around the implanted embryos on Days 7 and 8. Biacore and immunoprecipitation analysis determined that TINAGL1 linked with ITGA5 and ITGB1 in the decidual endometrium. These results suggest that Tinagl1 functions during the postimplantation period; in particular, it associates with ITGA5B1 in the decidualized uterine endometrium.

Autologous chondrocyte implantation with a Reveille cartilage processor for articular cartilage injury: a case report.

Autologous chondrocyte implantation (ACI) is an important operative option when repairing cartilage defects of the knee. This report introduces a new product development with one-stage ACI using a Reveille Cartilage Processor (Reveille CP) as well as the assessment of MRI and clinical results at a 1-year follow-up. The report compared cases between a 42-year-old female who underwent ACI surgery using Reveille CP and a 51-year old female who received treatment with two-stage ACI of tissue-engineered cartilage-like tissue (J-TEC Autologous Chondrocyte Cultured Cartilage [JACC]). One year after JACC, magnetic resonance imaging (MRI) showed signal intensity area in the grafted area, while patients with Reveille CP showed greater thickness than the surrounding healthy cartilage. The Lysholm, pain and QOL scores of Knee Injury and Osteoarthritis Outcome (KOOS) at one 1 year after surgery with Reveille CP were higher than JACC.

Tubulointerstitial nephritis antigen-like 1 is expressed in extraembryonic tissues and interacts with laminin 1 in the Reichert membrane at postimplantation in the mouse.

Tubulointerstitial nephritis antigen-like 1 (Tinagl1, also known as adrenocortical zonation factor 1 [AZ-1] or lipocalin 7) has been cloned from mouse adrenocortical cells and is known to be closely associated with zonal differentiation of adrenocortical cells. In cell culture systems, TINAGL1 is a matricellular protein that interacts with both structural matrix proteins and cell surface receptors. However, the physiological roles of TINAGL1 and regulation of its expression are still not clearly understood. In the present study, the expression and localization of TINAGL1 in peri-implantation mouse embryos was examined. During preimplantation, the expression of both Tinagl1 mRNA and TINAGL1 protein was increased just prior to implantation. In blastocysts, TINAGL1 expression was localized to the trophectoderm. Using a progesterone-treated, delayed-implantation model, TINAGL1 was found to be upregulated in implantation-competent blastocysts after estrogen treatment. During postimplantation, TINAGL1 expression was restricted to extraembryonic regions. Marked expression was detected in the Reichert membrane on Embryonic Days 6.5 (E6.5) and E7.5. Colocalization of laminin 1 and TINAGL1 was also examined. Using an anti-LAMA1 antibody, colocalization of LAMA1 and TINAGL1 was observed in postimplantation embryos. Colocalization was also detected in the Reichert membrane. Immunoprecipitation analysis determined that LAMA1 and TINAGL1 interact in embryos on E7.5. These results demonstrate that after implantation, TINAGL1 is an extraembryonic tissue-specific protein. In particular, TINAGL1 is a novel component of the Reichert membrane that interacts with laminin 1. These results suggest that TINAGL1 most likely plays a physical and physiological role in embryo development at postimplantation.